CMS announces new Medicare fraud deterrent measures

CMS announced new rules to strengthen the oversight of Medicare claims and reduce abusive billing practices that it projects will save more than $327 million annually in taxpayer funds.

“The changes announced today are common-sense safeguards to preserve Medicare for generations to come, while making the rules more consistent for all providers that work with us,” Marilyn Tavenner, CMS administrator, said in a press release. “The administration is committed to using all appropriate tools as part of its comprehensive program integrity strategy shaped by the Affordable Care Act.”

The new measures include denying enrollment to providers, suppliers, and owners affiliated with any organizations that have outstanding Medicare debt to prevent the ability to re-enroll under another name or organization. A provider’s or supplier’s enrollment also may be denied or revoked if one of its employees has been convicted of a Medicare-related felony. Enrollment will be denied or revoked if a provider or supplier has demonstrated a pattern of billing abuse or billing for services that do not meet Medicare standards.

“CMS has removed nearly 25,000 providers from Medicare and the new rules help us stop bad actors from coming back in as we continue to protect our patients,” Shantanu Agrawal, MD, CMS deputy administrator and director of the Center for Program Integrity, said in the release. “For years, some providers tried to game the system and dodge rules to get Medicare dollars. Today, this final rule makes it much harder for bad actors that were removed from the program to come back in.”

Currently, CMS has a temporary moratoria on new enrollments in “seven fraud hot spots around the country” in the ambulance and home health sectors. Background check requirements and a fraud prevention system using predictive analytics technology have identified providers and suppliers CMS has since revoked, preventing claims payments of $81 million, according to the release.